Tuesday, April 14, 2009

Is a physician obligated to tell you when their clinic has been confirmed as a source site for a highly contagious virus or a potentially lethal form of an antibiotic-resistant superbug?

Apparently, here in Manitoba, the answer is no.

But to be fair, Manitoba's doctors really need feel no obligation to alert their patients when their clinics are confirmed as vectors for the spread of such illnesses such as the Norovirus, methicillin-resistant staphylococcus aureus (MRSA), C. difficile, and vancomycin-resistant enterococci (VRE). After all, why should they be held to a higher standard than the Winnipeg Regional Health Authority (WRHA)? According to Free Press, the WRHA feels it needn't apprise us of such outbreaks in our hospitals - so why should we expect anything different from our community doctors?

Here in Manitoba, the WRHA believes that publicizing confirmed outbreaks of contagions that can cause severe diarrhea and dehydration, skin rashes, boils, "severe blood infections, pneumonia and even death" is unnecessary. Evidently, the WRHA does not feel it is in the public interest for people to know if the facility they are visiting (for whatever reason) has confirmed cases of MRSA, Norovirus, etc.,

According to the WHRA's director of infection control, Dr. Embil (Embilcile?), any furor over the Authority's failure to notify is really much ado about nothing. After all, he says, the WRHA can "anticipate outbreaks every year".

"This is all old news. Quite honestly, this is no news. It happens, it's the reality of taking care of sick people."

Yes Dr. Embil-cile, of course such outbreaks are bound to occur. As for your ability to "anticipate"? Whoopee! Well done Sherlock! Bet you even have the ability to "anticipate" that "every year" you may see a patient or two present with a heart attack, a stab wound, or maybe even a baby? Course, none of these are contagious. And therein lies the problem. When it comes to known outbreaks of contagions that are uncontrolled within our hospital settings you (Dr. Embil-cile & co.) have a duty to inform. Unless, of course, you really believe that all the other jurisdictions across North America who have decided disclosure is the better part of valour in the battle against superbugs are wrong?

As a Canadian Medical Association Journal (CMAJ) article in 2006 pointed out, there are serious public health implications associated with MRSA outbreaks in community settings. Schools, daycares, etc., are all at risk. And according to CMAJ, all strategies for the successful control of the spread of such infections hinge on two factors: public awareness of the problem and public education. So, when an outbreak is verified in a Winnipeg hospital setting why is it not publicized? Why is the public not informed in a timely fashion? Given that the community based strains of MRSA (CA-MRSA) "aremost frequently described within reasonably well-defined populations"; is it not be reasonable to expect that when a outbreak occurs within a similarly easily defined population (i.e. the staff, patients, and visitors to a specific hospital) that the public be notified of the associated risks of exposure should they visit the hospital?

Dr. Embil-cile, no one is particularly blaming you for the MRSA, Norovirus, and C. difficile outbreaks at your facilities. But in the same way that such outbreaks are (largely) unavoidable in hospital settings, icy roads happen in winter. However, at least weather reporters make an effort to tell us of icy conditions when they occur to help us make informed decisions before we hit the highway. Is it too much to ask that the WRHA not do the same when it comes to periodic adverse germ events within the walls of its hospitals? Why not give people who are choosing to visit a site afflicted with an unresolved outbreak the info they need to make an informed decision? Does one take little Billy or Nancy in to see Grampy in the critical care ward if they know his wing is experiencing an MRSA event? Maybe. Maybe not? But, at the very least, they should have all the facts as they become available. Surely one should not have to file a freaking FIPPA request just to find out if our PUBLIC hospitals pose an exceptional threat to our personal health.

It's about time the WRHAdemonstrated a little institutional responsibility. Transparency never hurt anyone (well, unless of course they were guilty of doing something wrong). At this juncture, nobody is accusing the WRHA of anything more than repeatedly exercising poor judgement. The WRHA must stop withholding information on known outbreaks. If it is true that from 2006-08 that 803 patients and 609 hospital staff in Winnipeg were infected with the illnesses in question, then Joe & Jane Public have a right to that data. If there is currently an outbreak not under control within this city then it should be made public. That professionals like Dr. Embil-cile believe such outbreak events are "old news" is not the point. The point is that "news" only becomes "old" after the facts are known.

Ongoing or persistent outbreaks are news. Especially when they impact the lives of 700-1000+ people per year in this city. Just release the facts WRHA - its not up to you to decide what is "no news" or "old news". In this case, control freak doctor-administrators do not "know best" what constitutes real news. That privilege, especially in a public system such as ours, belongs rightfully to the people: you know the one's who pay the bills.